정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

老齡者의 建康을 위한 生活習慣 實態調査

申東敏,長鳳愚,李揆文,金賢俊,金昌範,崔宗洙,崔鍾晥,李鍾珏,金圭碩,趙庚旭,金鍾聲,朴鍾振 平生體育硏究所 論文集 1987 平生體育硏究所 論文集 Vol.2 No.-

With a view to examining the habit and method in which old people maintain and improve their health, we consulted 551 men and 444 women who were over 65 years old, and concluded as follows: 1. Habit of eating It's been revealed that most of the old people keep a regular eating hour, control the quantity of meal or eat a little food, and prefer vegetables to meat. 2. Mental health Old people feel the necessity for mental health and most of them (about 80%) keep good mental health without becoming pessimistic. Their chief concenrs have turned out to be about their sons and daughters and their own health and finance. 3. Managing Good Health It has been revelaed that old people do not possess any special kind of secret to keep good health but taking plenty of rest, regular meal, and proper exercise, and many of them (about 60%) have been shown to eat invigorant food that they can easily get around their living area. 4. Physical Functions It has been revealed that many old people are conscious of some symptoms about their parts of body and about to percent of them suffers from neuralgia. Some measures like medical aid especially for old people need to be taken as soon as possible. As we have found that the health-keeping method of old people consists plenty of rest, proper exercise, and appropriate nutrition, we can conclude that the recreatonal and culture facilities and programs for keeping old people in good health should be developed. It is also necessary to study food that contribute to their health and develop ways to get rid of the stresses to which they are exposed in their daily life. Presides, it is natural that government found an administrative department to deal with these matters effectively.

하악골에 발생한 골막 골육종

김태우,김승범,권혁찬,문선재,윤정훈,김형준,차인호,육종인,김진 대한악안면성형재건외과학회 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.1

Periosteal osteosarcoma is a distinct entity of malignant bone tumor with characteristic clinical, morphological, and histological features within the group of juxtacortical osteosarcoma. Periosteal osteosarcoma is predominantly located in the tubular long bones, and extremely rarely involving the jaws. A case of periosteal osteosarcoma of the right mandible is presented. A 27-year-old woman complained of the gingival swelling and bleeding tendency of the right posterior mandible. Clinical examination revealed a reddish brown strawberry-like swelling on the affected mucosa, which measured 1.5㎝×1.5㎝. The tumor was located on the lingual cortex of the mandible and extended into the surrounding soft tissues. Microscopically, the tumor consisted exclusively of atypical chondroblastic cells with a small osteoblastic area. A minimal bone marrow involvement was noted and the adjacent cortex was free of tumor. These findings suggested that the tumor originated from the periosteal cambium layer, which lies between the periosteal fibrous layer and the cortex of mandible.

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.

제조업체의 마케팅생산성 향상을 위한 CRM 연구 : S'전자업체를 중심으로

김상종,이범희 한국생산성학회 2005 生産性論集 Vol.19 No.1

While most of researchers studied on the value added performance of CRM (Customer Relationship Management) operation in the field of banking industry, not manufacturing industry, this study is on the performance of CRM operation of S' Electronics Corporation, which produces electronics goods. Conceptually, the CRM of Manufacturing industry should be different from the one of banking industry. Manufacturers usually don't invest much in the CRM activities, because they have many difficulties in gathering the customer's real information. The fact leads us to study the CRM for the improvement of the Marketing Productivity in the manufacturing industry like S' Electronics Corporation. In this study, the main focuses for manufacturers are about how to use a lot of customers' information for CRM operations. First, we divided the customer informations to the three different kinds of groups like the three independent variables RFM (Recency, Frequency, Monetary). And, selected the P (marketing Productivity) as the dependent variable. From the analysis, we could evaluate a lot of regression equations for every individuals, nearly more than 20 million customers' information in S' Electronics corporation. CRM marketers can utilize the regression equations, by using computer system, which can lead to the improvement of Marketing Productivity. The improvement of the CRM activities in manufacturing industry was verified almost the same as the banking industry. And, we found the improved real performance of CRM Marketing Productivities in S' Electronics corporation.

흰쥐에서 반복적 스트레스가 GABA성 신경전달에 미치는 영향

김창수,이종범,성형모,시현석,김진성,박형배,정성덕,하정희 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

연구목적 : 일반적으로 생체는 각종 스트레스에 반응하여 적응(adaptation) 기전이 나타난다. 이러한 적응 기전과 관련하여 포유동물의 중요한 억제성 신경전달계인 GABA성 신경전달계의 스트레스성 자극에 대한 반응양상에 대한 연구가 진행되고 있다. 신경전달의 변화양상은 부하된 스트레스의 종류 및 기간에 따라 다양하게 나타나므로 더욱 상세한 연구를 필요로 한다. 방 법 : 본 연구에서는 하루 2시간의 부동화 스트레스를 반복적으로 2주간 부하한 흰쥐의 뇌조직에서 GABA성 신경전달의 변화 양상을 관찰하고자 하였다. 수용체 결합반응을 통하여 GABA 수용체의 각 component별 배위자들의 각 수용체에 대한 결합 반응의 변화 양상을 정상 대조군와 비교하여 보고, 유의한 변화가 있는 부분의 상세한 검정을 위하여 포화결합반응을 통하여 친화력(Kd) 및 최대결합력(Bmax)에서의 변화양상을 검색하였다. 뿐만 아니라 GABA성 신경전달에 관여하는 중요한 신경전달체인 내인성 GABA의 함량과 대사효소인 GABA transaminase의 활성도의 변화양상도 검색하였다. 결 과 : 연구결과 반복적인 부동화 스트레스는 GABA 수용체 효현제인 [³H]muscimol의 흰쥐 뇌조직 GABA 수용체에 대한 결합도에는 별다른 영향을 미치지 않았다. 대뇌피질조직의 GABA 대사효소인 GABA transaminase 활성도를 감소시켰으나, 피질조직외의 다른 조직의 GABA transaminase 활성도나 내인성 GABA의 농도에는 별다른 영향을 미치지 않았다. 반복적인 부동화 스트레스를 부하한 흰쥐의 대뇌피질, 해마 및 시상하부 조직에서는 [³H]flunitrazepam의 수용체 결합도가 감소하였으며, 포화결합 반응결과 수용체의 수가 감소하였음을 확인하였다. 결 론 : 이상의 결과를 요약하면, 흰쥐에게 부하한 반복적인 부동화 스트레스는 뇌조직의 benzodiazepine 수용체의 수를 감소시킴으로써 GABA성 신경전달을 감소시키며, 이러한 GABA성 신경전달계의 변환은 생체에서 스트레스로 인한 행동장애의 한 기전이 될 수 있을 것으로 생각되었다. Objectives : Changes of GABAergic neurotransmission in response to the application of different types of environmental stress have been the subject of research for over two decades. However, the nature of the changes induced by stress appear to show a dependent phenomena on the type and duration of stressor agent employed. Methods : For this reason, this study was performed to observe the effects of repeated stress on the radioligands binding to GABAA/benzodiazepine receptors of discrete brain regions. The author also examined the activity of GABA transaminase and the concentration of endogenous GABA. Male Sprague-Dawley rats, weighing 150-200g were forced to suffer an immobilization stress for 2 hours during 14 consecutive days. Results : Repeated immobilization stress decreased the binding of [3H]flunitrazepam on the benzodiazepine receptor in the cortex, hippocampus and hypothalamus. Saturation experiments followed by scatchard analyses of the results showed decreased density of benzodiazepine receptor and the affinity remained unchanged. Repeated immobilization stress did not affect the binding of [3H]muscimol on the GABAA receptor, the activity of GABA transaminase, and the concentration of endogenous GABA in the brain regions. Conclusions : From these results, it can be concluded that repeated immobilization stress modulated GABAergic neurotransmission via downregulation of the benzodiazepine receptor in the brain.

흰쥐에서 급성 스트레스 유발 불안반응의 해소에 대한 신경교세포 말초성 벤조다이아제핀 수용체의 매개작용

김영욱,박형배,이종범,김진성,정성덕,하정희,송창진 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

연구목적 : 말초성 벤조다이아제핀 수용체가 스트레스로 유발된 불안반응에서의 불안해소작용을 알아보기 위해 흰쥐에 급성 부동화(immobilization) 스트레스를 부하하여 유도된 불안반응에서 뇌조직중의 말초성 벤조다이아제핀 수용체의 매개작용을 검색하고자 본 연구를 시행하였다. 방 법 : 흰쥐에 급성 부동화 스트레스를 가한 후 실험동물의 불안도를 elevated plus maze를 통하여 검정하고 말초성 벤조다이아제핀 수용체의 변화를 수용체 결합반응을 통하여 검색하여 대조군과 비교했고, 말초성 벤조다이아제핀 수용체 효현제 및 길항제의 투여에 의한 실험동물의 불안도의 변화 양상도 동일한 검사를 통하여 검정하였다. 결 과 : 급성 부동화 스트레스에 부하되었던 흰쥐는 불안반응을 나타내었으며, 실험동물에 선택적인 중추성 벤조다이아제핀 수용체 효현제인 clonazepam을 투여하여 스트레스로 인한 불안반응을 감약시킨 후 급성 부동화 스트레스를 가했을 때는 불안반응이 감약되었으며, 후구(olfactory bulb)의 말초성 벤조다이아제핀 수용체의 상향조절도 관찰되지 않았다. 말초성 벤조다이아제핀 수용체 효현제인 Ro5-4864을 투여 후 약한 불안 해소 작용을 나타내었으며, 신경활성 스테로이드의 전구물질인 progesterone을 흰쥐에게 투여한 후 이 실험군의 통로로의 진입율 및 개방통로에서의 체류율은 대조군에 비하여 유의하게 증가되었다. 결 론 : 말초성 벤조다이아제핀 수용체는 급성 스트레스 부하시 야기되는 불안반응에서 내인성 GABA성 신경전달의 조절자로 알려진 신경활성 스테로이드의 합성을 증가시킴으로써 불안반응을 해소하는 기능을 가진다. Objectives : Peripheral benzodiazepine receptor has been suggested to be associated with the relief of anxiety response induced by stresses. This study was designed to observe the anxiolytic activity of peripheral benzodiazepine receptor. Methods : Male Sprague-Dawley rats, weighing 200-250g were forced to suffer an immobilization stress for 2 hours. The level of anxiety by immobilization was performed by an elevated plus maze and was evaluated by the number of [³H]Ro5-4864 binding sites in the olfactory bulb. Results : Saturation experiments followed by scatchard analyses of the results showed that the density of peripheral benzodiazepine receptor increased and the affinity of the peripheral benzodiazepine receptor remained unchanged. It was found that there was no significant change in the cerebral cortex. Pretreatment with clonazepam, a central benzodiazepine receptor agonist, before an immobilization stress abolished the anxious response on the performance of plus maze. In this group, upregulation of peripheral benzodiazepine receptor of olfactory bulb was not observed. Ro5-4864, a peripheral benzodiazepine receptor agonist, elicited an increase of anxiolytic response on the performance of plus maze. Progesterone, a precursor of neuroactive steroid, also increased anxiolytic response on the performance of pius maze. Pretreatment with PK11195, a peripheral benzodiazepine receptor antagonist, abolished the anxiolytic effect of progesterone. Conclusions : From these results, it could be concluded that peripheral benzodiazepine receptor is closely associated with the relief of acute stress induced anxiety response via an increase of synthesis of neuroactive steroid.

마우스에서 전기자극 스트레스의 면역조절 효과

김정범,박종욱,배재훈 대한생물치료정신의학회 1996 생물치료정신의학 Vol.2 No.2

전기자극 스트레스가 마우스의 면역계에 미치는 영향을 조사하기 위해 체액성과 세포성 면역반응을 조사하고, 이 면역반응 결과에 대한 면역조절 기전을 이해하기 위해 전기자극 스트레스가 사이토카인의 유전자 발현에 미치는 영향을 조사하였다. 생체내 면역반응을 평가하기 위하여 흰쥐 적혈구에 대한 특이항체생성반응은 스트레스군에서 대조군보다 항체생성반응이 감소하였다. DNFB에 대한 접촉성 과민반응 실험에서 T24는 스트레스군과 대조군 간에 차이가 없었으나 T48는 T24에 비해 스트레스군에서 증가를 보였다. Phytohemagglutinin으로 자극된 비장 단핵구의 증식에 미치는 영향을 알아보기 위해 ³H-thymidine incorporation 검사를 실시한 결과 스트레스군에서 대조군보다 세포증식반응이 증가되었다. 전기자극 스트레스에 의한 면역조절 기전을 이해하기 위하여 사이토카인의 유전자 발현을 조사한 결과 스트레스군에서 대조군에 비해 IL-2, IL-6의 유전자 발현이 억제되고 IL-1, IL-12,GM-CSF,MIF등의 유전자 발현에는 대조군과 차이가 없음을 보였다. 이상의 결과를 볼 때 전기자극 스트레스에 의해 체액성 면역반응이 저하된 현상은 면역반응 활성화와 항체 생성에 중요한 IL-2및 IL-6 유전자 발현의 억제와 연관이 있을 것으로 생각되며, 스트레스군에서 IL-2 유전자 발현의 억제에도 불구하고 mitogen에 의한 세포증식반응이 증가한 현상을 해명하기 위해서는 보다 다양한 실험조건의 적용이 필요하며 더 나아가 스트레스에 의한 동물의 행동반응 또는 신경내분비계에서 나타날 수 있는 변화들과의 연관성에 대한 계속적인 연구가 필요할 것으로 생각된다. To explore the molecular mechanisms by which electric footshock has immunomodulatory effects, the effects of electric footshock, on the humoral and cell-mediated immune responses of ICR mice and then the gene expression of cytokines in splenocytes, including interleukin-1(IL-1), IL-2, IL-6, IL-12, the migration inhibitory factor(MIF), and the granulocyte macrophage-colony stimulating factor(GM-CSF), were investigated. Mice were subjected to electric footshock for 3 days(two sessions a day, 11 footshocks a 31-min session). The humoral response was measured using ICR mice immunized with rat RBC. The cell-mediated immune response was evaluated by contact. hypersensitivity to 2,4-dinitrofluorobenzene(DNFB) and by phytohemagglutin(PHA)-stimulated splenocytes proliferation assay. In the stressed group, electric footshock suppressed significantly the anti-rat RBC antibody(P<0.05), but enhanced significantly T48 relative to T24 in contact hypersensitivity(P<0.01) and T-cell proliferation response(P<0.05) by PHA stimulation relative to the control group. The gene expression of IL-2 and IL-6 were suppressed significantly in PHA-stimulated splenocytes, but that of IL-1, IL-12, GM-CSF and MIF were not. In conclusion, suppressed IL-6 gene expression seems to account for suppressed humoral immune response. In spite of enhanced cell-mediated immune response, the result is that IL-2 gene expression was suppressed, which suggests the two putative mechanisms. Firstly, while in the stressed group production of IL-2 occurs rapidly and thereafter declines abruptly, in the control group that of IL-2 occurs slowly and thereafter declines gradually. Secondly, there may be certain detouring circuits extending the signal conduction system by IL-2 except the usual signal conduction system.

폐쇄성 황달로 내원한 담관내 증식을 동반한 간세포암 1예

김승범,김태년,이호찬,박재현,은종렬,장병익,이헌주,윤성수,배영경 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

The incidence of hepatocellular carcinoma presenting as obstructive jaundice is 0.7 -9% The mechanisms of obstructive jaundice include bile duct invasion by tumor, tumor thrombi, blood clots, direct bile duct compression by tumor, and intraductal tumor growth. We report a rare case of hepatocellular carcinoma with intraductal growth A 46-year-o1d woman was admitted due to colicky right upper abdominal pain and jaundice for 4 days Computed tomography showed dilatation of the left intrahepatic duct, and endoscopic retrograde cholangiography showed a filhng defect in the left main intrahepatic duct. We performed a left lobectomy with a Roux-en-Y hepaticojejunostomy. The tumor was diagnosed as a hepatocellular carcinoma with intraductal growth.

운동특성에 따른 체구성과 골조성의 비교

김창범,박종진 충북대학교 평생체육연구소 2000 平生體育硏究所 論文集 Vol.12 No.-

This study was to analyze the body and bone compositions according to exercise characteristics. 32 subjects attending universities consisted of 8 track players, 8 tennis players, 8 wrestling players, and male students. A whole body scanner (model:dual X-ray absorptiometry, LUNA) was used to measure body composition components, bone mineral content, total bone calcium, bone mineral density, Comparisons of each group's bone densitometry numerics revealed following results. First, %body fat and fat body weight were significantly lower in track players, while lean body weight was significantly higher in wrestling and track players. Second, bone mineral content was significantly higher in wrestling players arms and body and track players' leg. Third, total bone calcium was significantly higher in wrestling players. Fourth, bone mineral density was significantly higher in track, wrestling and tennis players' pelvis and wrestling players' all the other parts. In sum, endurance training like track play had positive effects on developing appropriate body composition, while wrestling characterized by heavy weight, excessive and continuous exercise, and high loading had positive effects on developing appropriate bone composition. Hence, endurance training involving high loading and dynamics would be effective sports for developing appropriate body compositions.